Laparoscopic repair of missed blunt diaphragmatic rupture using a prosthesis

Abstract

A 54-year-old man underwent a therapeutic laparoscopy for giant diaphragmatic rupture complicating a blunt trunk trauma that had occurred 13 months earlier. Laparoscopy revealed a left hemidiaphragm 12-cm defect with an intrathoracic herniation of the omentum, the entire gastric fundus, the splenic flexure of the colon, and the two upper thirds of the spleen. The defect was not suitable for primary suture due to the diaphragmatic edges retraction. We repaired the hernia using a large polypropylene mesh covering the defect with 2-cm overlap. There was no intraoperative surgical or anesthetic complication. Postoperative course was uneventful and 3-month follow-up confirmed the healing of the diaphragmatic hernia. This case is discussed regarding the safety of the procedure, the best minimally invasive approach, and technical aspects of the repair.

The role of laparoscopy in the diagnosis and treatment of missed diaphragmatic rupture

“…However, we prefer the use of laparoscopy for the delayed diagnosis and treatment of missed diaphragmatic rupture. Our preference is based on the ease and safety with which adhesions can be released with laparoscopy, the merits of avoiding double-lumen intubation, and the ability to repair large diaphragmatic defects [2,5,8].…”

“…With the development of laparoscopic surgery during the last decade, laparoscopy can now be used in the treatment as well as the diagnosis of the injury. However, this approach has been described in only a few papers that focused on single cases [6,8]. The aim of this paper is to summarize our experience with the laparoscopic diagnosis and treatment of missed diaphragmatic injuries.…”

Laparoscopic correction of experimentally induced diaphragmatic rupture in dogs

“…One study that mentions insufflation pressure for correction of diafragmatic rupture in clinical conditions used 10 mmHg. In that study, the authors postulated that low pressure should be used to avoid CO 2 passage through the mediastinum with potential complications 24 . In our study, using 6 mmHg insufflation, it was possible to observe CO 2 passage to both hemithoraxes, leaving the chest in a barrel shape.…”

A Delayed Traumatic Diaphragmatic Hernia Presenting With a Bowel Obstruction 20 Years Postinjury

“…The diaphragmatic defects should be closed with permanent sutures, placed in an interrupted fashion, and reinforced with pledgets, so that they do not pull through the thin musculature of the diaphragm when they are tied in place. This is most commonly done via a laparotomy, although this has been approached via a thoracotomy, and also with laparoscopic and thoracoscopic techniques [5,11,12]. The postoperative complications include pneumothorax, atelectasis, recurrence of the diaphragmatic hernia, ileus, and intraabdominal adhesions.…”